In health insurance, a “concentric” or “efficient” provider network is a strategically designed network of healthcare providers and facilities. The primary goal is to offer high-quality care while minimizing unnecessary costs. This is achieved by including providers who meet specific standards for quality and cost-effectiveness in patient care.
Such networks are typically more streamlined compared to broader networks, focusing on a core group of providers who have a proven track record of delivering effective, efficient healthcare. This approach often involves rigorous vetting of providers based on various performance metrics, including patient outcomes, adherence to best practices, and cost efficiency.
The advantage for insured members is access to a selection of providers who are not only competent but also more likely to provide care in a cost-effective manner. However, the trade-off might be a more limited choice of providers and facilities compared to larger, more expansive networks.
This concept is part of a broader trend in healthcare towards value-based care, where the focus is on achieving the best health outcomes in the most cost-effective way.